Using a second generation immunotherapy drug for the long-term management of a common type of blood cancer has been shown to give patients more durable control of their cancer. A clinical trial has shown patients who took the antibody drug Obinutuzumab together with and after their chemotherapy had a 34% reduced risk of their disease getting worse, over three years.

This was compared to our current standard therapy which instead uses the first generation version of a similar antibody drug Rituximab in the same manner.

The trial involved more than 1,200 patients - many treated at Peter Mac or Monash Health - with follicular lymphoma and a paper reporting the outcome is published online today by the New England Journal of Medicine.

“We know standard treatment with chemotherapy and an antibody can suppress cancer activity for several years but, for many patients, effectiveness will wane and a relapse will occur,” says co-researcher and Peter Mac’s Director of Haematology, Professor John Seymour.

“Broadly we are looking for ways to improve and extend the durability of this response and, in this clinical trial, we’ve identified a drug that does this and is already available and funded in Australia for a related disease, chronic lymphocytic leukaemia.”

Obinutuzumab is already used to treat other types of blood cancer and, in follicular lymphoma and other non-Hodgkins lymphomas, it is used as a second-line treatment in cases where patients no longer respond to Rituximab.

The trial data supports Obinutuzumab’s use as the first-line treatment in follicular lymphoma.

Patients in the trial were split into two groups who received chemotherapy with an antibody drug and then ongoing antibody drug; either Rituximab (standard therapy) or Obinutuzumab. At follow-up three years later:

  • Progression-free survival was 73.3% in the standard therapy group, compared to 80% in the Obinutuzumab group.
  • The proportion of patients alive was 92.1% for standard therapy (46 deaths) compared to 94% in the Obinutuzumab group (35 deaths).
  • There were more high-grade adverse events in the Obinutuzumab group, but a similar frequency of fatal adverse events in each group.
  • The overall relative reduction of risk of cancer progression, or death, in the Obinutuzumab group was 34%.

Both Obinutuzumab and Rituximab are anti-CD20 monoclonal antibody drugs, an emerging new class of targeted immunotherapy drugs.

“This is a cancer we cannot yet cure but newly emerging immunotherapy drugs, used in conjunction with conventional chemotherapy, are giving us powerful new tools to extend patient lives,” says Prof Stephen Opat, from Monash Health, and who was also on the international clinical trial research team.

“This clinical trial data supports the use of Obinutuzumab as the first-line treatment in the immuno-chemotherapy and maintenance setting for previously untreated follicular lymphoma, as it would give patients a significant improvement in progression-free survival.”

The trial also involved researchers from the UK, Japan, Germany, Canada, Prague, Czech Republic and Switzerland.